The Fran Report

=== Table of Contents ===

News
"Fran's Odyssey"
Health
Medical News
Strokes
TIA's
Aphasia
Apraxia
Therapy
Conclusion
Fran's current address and telephone contacts
Maps to Fran's new home in San Mateo
E-mail

General News   July 20, 2002

Fran's condition continues to improve, but Fran is getting lonely.  She would love to have more visitors any day and almost any time (visiting hours at the small "board and care" home where she's now living are 9AM-8PM daily).

The other residents at the house provide very little intellectual stimulation, and visits from her family aren't really enough to keep her daily life from being rather boring, but if her friends all visited her occasionally or even just phoned her, she'd have a much richer life.  Please phone her (650-345-3455)!

She is able to travel from her residence with anyone who knows how to properly assist someone who's confined to a wheelchair (such as knowing how to safely transfer her in and out of a car).  Those who can't do that can still take her for wheel chair rides in her neighborhood.  She's also only one block from several neighborhood restaurants (including excellent Chinese and Japanese restaurants).  Her home is also only 3 blocks (on foot) from the Hillsdale Mall, a huge shopping center.  Getting out of the house for a short while with friends or just visiting with them at the house always cheers Fran up.

Three of her sister 99s from the Santa Clara Valley Chapter, Susan Larson, Pat Lowers, and Marcie Smith, have taken Fran on several flights in their planes recently, and Susan has been a regular visitor of Fran's since she first was hospitalized in Nov. 2001.  Those who know Fran best know that she lives to fly (having soloed in 1940), so flying with such great friends, enjoying being with them, has improved her life immensely.  These flights and the camaraderie involved have been a great "picker-upper" for her.  [Thank you very much, Susan, Pat and Marcie!]

For those who have not yet heard, Fran suffered at least two minor strokes on or about Nov.3, 2001.  She probably suffered one or more TIA's (stroke predecessors) in the days prior to her admission to Peninsula Hospital in Burlingame, Calif., on Nov. 3, 2001.

She was released from the hospital on Nov. 30, and became a patient at Hillsdale Manor Skilled Nursing Facility, a convalescent hospital in San Mateo.

Both Fran's overall condition and her spirits have been slowly but steadily improving.  Aside from being confined to a wheelchair most of the time, Fran also has some minor speech problems, but those who already know her will quickly adjust to them and will have no problem conversing with her, especially if they read the following sections on this website: Apraxia and Aphasia, noting in particular Fran's specific (and now rather minor) versions of these problems.

On May 14, 2002, she was moved out of the convalescent hospital and into a "board and care" home nearby, thanks to improvements in her condition.

"Fran's Odyssey"   May 15, 2002

Until Nov. 3, 2001, Fran Grant was living at a retirement community in Millbrae, in a 4th-floor apartment looking straight up Runway 1-Left at San Francisco International Airport (SFO).

On Nov. 3, she ended up at Peninsula Hospital in Burlingame (5 blocks from her apartment).

On Nov. 30, Fran was moved to a skilled nursing facility in San Mateo (less than 2 miles from her son's house in Belmont), where she spent several months recovering.  She was able to move out of there on May 14, 2002, but she will not ever be returning to her Millbrae apartment.

In May 2002, she moved to a residential "board and care" facility in San Mateo, where she has her own bedroom in a 6-resident home, sharing the living room, dining room and yard.  She has full-time caretakers available to her as necessary.

Please see Health for much more information.

Health (July 20, 2002)

Medical News   July 20, 2002

For more than two months, Fran has been living in a small (6 residents) "board and care" home on West 38th Ave. in San Mateo, just one block West of El Camino Real, just South of the Hillsdale Mall.  Because of stroke damage, she is now usually confined to either a wheelchair or her bed, but she's no longer in a medical environment.  She has her own bedroom and half-bath in a suburban home, watches TV a lot, and takes her meals in the dining room with the other residents.

Fran is free to travel away from her new home as often as she wants, but needs someone to push her wheelchair.  She is able to travel in a car or van with anyone who knows how to properly assist someone who's confined to a wheelchair (such as knowing how to safely transfer her in and out of a vehicle).  She has already been flying in small planes twice since the beginning of May.

Fran misses participating in the activities she used to be involved in before her strokes and especially misses seeing all of her friends and acquaintances.  She loves having visitors any time, so call her or just show up (she's usually home these days). ;-)

=== May 15, 2002

Fran's condition has improved enough that she was moved May 14, 2002 from the Hillsdale Manor nursing home to a "board and care" facility nearby.  Her phone number is still (650) 345-3455.

On May 12, Fran went flying again with Susan and Pat.  On her return, Fran still had plenty of energy -- she's getting back to being her old self again!

=== April 7, 2002

Fran's condition improved so much that her physician gave her permission to go on a short flight on March 19 with her good friend, Susan Larson (also a member of the 99s).

In mid-April, she and Susan drove to San Francisco to attend a concert in which their fellow 99, Pat Lowers, was performing.  Everyone had a great time.

Strokes

As mentioned in the "synopsis" above, Fran suffered one or more ischemic strokes on Nov. 3, and probably on Nov. 5.  She probably suffered one or more TIA's (transient ischemic attack, also often referred to as "stroke predecessors") in the days and weeks prior to her admission to Peninsula Hospital in Burlingame, Calif., on Nov. 3, but her symptoms were probably not sufficient to be recognized by anyone except medically trained personnel.  Fran's strokes were probably cerebral thromboses (small blood clots in the brain); for more detailed information about stroke syndrome, please click here: my.webmd.com/content/asset/miller_keane_31587.

Fran was hospitalized for 4 weeks, then transferred to a skilled nursing facility (convalescent hospital) in San Mateo.

Although not paralyzed in any way, Fran has extreme weakness and minimal use of her right side ("hemiparesis"), as well as having problems with her physical equilibrium.  The "flexor" muscles in her right leg, arm and hand have contracted, while their opposites, the "extensor" muscles, have become too weak to overcome the flexor contractions.  This makes her unable to stand, even with help, today, but she is slowly making progress in recovery through physical therapy.

She can sit up in her hospital bed or in a wheelchair, but needs to be propped up with pillows usually.  On days when the weather is good, Fran has enjoyed wheelchair rides outside in the neighborhood.  Getting outside into the sunshine not only cheers her up but also stimulates her both mentally and physically.

Fran's powers of speech have been considerably diminished, at least temporarily, by a form of "expressive" aphasia, but her inability to talk well has nothing to do with her abilities to understand normal conversation, luckily.

TIA's

Please read the following.  Knowledge from it could possibly minimize stroke damage to you or a loved one sometime in the future.

transient ischemic attack (TIA)
Miller-Keane Medical Dictionary, 2000

A sudden episode of temporary symptoms typically due to diminished blood flow through the brain, usually defined as lasting between 24 and 48 hours.  It is sometimes related to impaired blood flow through the vertebrobasilar vessels.  The symptoms are warning signals of impending stroke; approximately one in three persons experiencing a TIA will have a "stroke syndrome" within 5 years.

The symptoms of TIA can range from obvious loss of sensation or motor function to more subtle changes in speech or mental acuity.  During the attack the person may feel numbness or weakness or both on one side of the body, slurring of speech or inability to talk, or difficulty in thinking.  Disturbance in the vision of one eye and double vision also are typical of TIA.  Because these signs are short lived, many persons may be inclined to ignore them unless they are informed of their importance and of the need to consult medical help before a catastrophic stroke occurs.  Carotid artery occlusions usually can be corrected by surgery.

Aphasia

On Nov. 5, Fran lost most of her powers of speech, but was able to speak a little bit by the next day, although most of her words sounded slurred. Her speech gradually improved as she underwent speech therapy at the hospital. On Nov. 16, she suddenly began to speak clearly, with no slurred words. Her speech continued to improve, but she was still very weak and quickly tired when speaking.  Sometimes her words would start to trail off while she was speaking.

Unfortunately, in early December Fran has lost most of her powers of speech again (see Medical Status, below).  Happily, Fran's mental abilities are completely unimpaired from how she was before all of this happened.  She has said that she is tremendously frustrated by her now usual inability to properly express herself verbally, but she's keeping her sense of humor anyway!  In February, according to her daughter-in-law, "The other day, she was having trouble pronouncing a word, paused, then said, sarcastically, 'Easy for me to say!', then laughed."

As of May 2002, Fran's speech is much improved from the above, with only occasional pauses and slurring of some words.  She continues to improve on a daily basis.  There's more information in the Therapy section.

Please, whether you're visiting her in person or on the phone, treat Fran the way you always have; just be patient in waiting for her verbal responses.  Her speech therapists have said that any speaking she does helps her progress.  Her doctors have said that all mental stimulation she gets is valuable, so visitors are definitely encouraged (visiting hours are 9 AM to 8 PM).  Don't forget: laughter is the best medicine!

We've done some research on the Internet and have a good idea of what has happened.  Fran's primary speech disability apparently is Transcortical Motor Aphasia (TMA).  It is related to Broca's aphasia which has somewhat similar symptoms.  Currently, the assumption is that it is TMA.

• Both of these are types of "expressive Aphasia" because they prevent the victim from speaking normally.


• If it's Broca's aphasia, damage from a stroke occurred in her lower left frontal lobe, one of the language areas of the brain (Broca's area).  People with Broca's aphasia (also called non-fluent aphasia) usually speak in short, meaningful phrases that are produced with great effort.  However, they are able to understand the speech of other people rather well.


• Transcortical Motor Aphasia or TMA is caused by damage to the cortical sections around Broca's area.  There is a minor difference in symptoms from Broca's Aphasia, which seems to fit Fran -- TMA victims do not speak unless they are prompted to do so.  When speaking, they use only short, sparse sentences, similar to those of patients with Broca's Aphasia, but they can repeat longer, complex sentences spoken by others.  As with Broca's Aphasia, they are able to understand the speech of other people rather well.

About 20% of all stroke victims suffer some form of aphasia.  Some FAQs and tips about aphasia can be found at Aphasia Hope, including data on how to communicate with Fran more effectively.  Then there's the National Aphasia Association with its data.  The best tips found so far were in an article entitled Talking With Individuals With Aphasia: Maximizing Communication Effectiveness.  Another good article is Patients give helpful tips for others by the University of Arizona Aphasia Clinic.

Apraxia

In addition to Aphasia, Fran also has been diagnosed with a mild form of Apraxia, which sometimes, but not always, affects her pronunciation.

What is occurring is that, as a result of a stroke, her brain sometimes is unable to get her lips, tongue and vocal cords to work together properly to form certain sounds.  The more practice she gets in speaking, the sooner her brain will relearn how to coordinate these motor functions properly and consistently.

Therapy   July20, 2002

Fran's "occupational therapy" (coaching in everyday tasks, such as feeding herself) was ended in early February because she met all the goals defined for her by the therapist!

As far as physical therapy is concerned, Fran was receiving treatment five days a week from a rehabilitation assistant and wearing a leg brace at night and a few hours per day.  This treatment was temporarily discontinued when Fran left Hillsdale Manor SNF, but in June a Rehabilitation Nursing Assistant trained by Fran's former Physical Therapist has been giving her physical therapy three days a week in her new home.  There has been noticeable improvement since then.

The strokes affected her right side in particular, but luckily, Fran is left-handed.  Although there has been very little improvement to Fran's right leg (which she cannot move independently), her right arm movement has definitely improved since February.

As of mid February, Fran had been working with a new speech therapist for several weeks, and her speech had improved noticeably.  The therapist's primary objective was to improve Fran's ability to communicate with others on an everyday basis, even if not always vocally.  For example, when Fran had trouble speaking (usually after sleeping or some other period of inactivity), she could express her needs (or even respond to someone) using a picture board that the therapist created specifically for her.  Because she could usually speak, Fran seldom used this, but would resort to it when necessary to improve communication.  This aid is no longer required at all!

She has recovered quite a bit physically, and the aphasia and apraxia have been overcome enough, via speech therapy, to allow her to have a better life, living in a small, group home now, as she and her children had planned before her strokes occurred.

UPDATE: May 15, 2002-- Fran's able to speak much more easily than in February, with fewer pauses and much more coherent speech.  She is still slurring her words somewhat and has trouble with a few speech sounds (such as the sound of the letter "B"), but it is now pretty easy to carry on a conversation with her.  As mentioned above, she is now in a group home nearby.

Conclusion

Recovery for Fran will be a long road, but every visitor will shorten that road.  She loves visits from all of her friends and family, and she is always cheered up by having visitors.

If you have any questions, please e-mail Fran's son, Bruce, or daughter, Judith (see below), or phone Bruce at 650-595-5961 (home phone, but his business phone is often forwarded there; don't be turned off by the answering machine's greeting for "Cost-Effective Solutions" when he's away from home).

If you'd like to send Fran e-mail, she has her own e-mail address, frang99@cesols.com.  Her son prints out all of her e-mails and delivers them to her.

This website will be updated as we learn more and as time allows.

Fran's address and telephone contacts

• Fran:  (650) 345-3455   (Fran can't always answer this, but you can leave voice messages here on the answering machine that normally will also simultaneously broadcast your message aloud in her room.  Remember that Fran's hearing is not the best, or she may be out of her room, or her TV may be on too loud for her to hear you, but usually she will hear you.  Her son, Bruce, always plays back all of Fran's messages for her almost every day before erasing old messages, so she will get your voice message eventually if not immediately.)


• Bruce Grant:  (650)595-5961   Please feel free to call Bruce at any time if you have questions about Fran.

Maps to Fran's location and e-mail information are below.

Maps

Maps to Fran's home, 39 West 38th Avenue, San Mateo

• Send E-mail to Fran (printed by Bruce Grant for personal delivery to her)


• E-mail comments to Bruce Grant (Fran's son)
• E-mail comments to Judith Grant (Vickers) (Fran's daughter)


• Go to Bruce & Lauri Grant's homepage
• Go to COST-EFFECTIVE SOLUTIONS Inc., Bruce Grant's primary business